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Cardiac Rehabilitation: Components, Benefits, and Barriers

Donna Polk, MD, MPH, and Diane Tran, MD

With the expanding and aging population, the prevalence of coronary heart disease (CHD) is escalating. Owing to advances in technological and medical treatment of CHD, more patients are surviving their index events and are, therefore, living longer, shifting the paradigm in the management of CHD to one of chronicity. The importance of cardiac rehabilitation (CR) as secondary prevention is evident from numerous randomized control trials demonstrating its mortality and morbidity benefit in patients with cardiovascular disease. However, despite its benefits, it is grossly underutilized. The identification of major barriers and under-represented groups such as women and the elderly is essential to the success of CR programs. Current CR programs include a multidisciplinary team of healthcare professionals that assists patients with chronic angina, recent coronary revascularization, valvular surgery, heart failure, and heart transplant to improve their cardiovascular fitness and quality of life. Acute Coronary Syndromes 2011;10(1):10–7.

Cardiogenic shock (CS) complicating ACS remains a common and frequently fatal disorder. The presence of ischemic and/or stunned or hibernating myocardium may have a profound impact on the initial, in-hospital, and post-discharge management and prognosis.

Donna Polk, MD, MPH, and Diane Tran, MD

Hartford Hospital, Hartford, CT, USA

With the expanding and aging population, the prevalence of coronary heart disease (CHD) is escalating. Owing to advances in technological and medical treatment of CHD, more patients are surviving their index events and are, therefore, living longer, shifting the paradigm in the management of CHD to one of chronicity.

Eugene C DePasquale, MD, and Alexandra J Lansky, MD

Yale University School of Medicine, New Haven, CT, USA

Direct thrombin inhibitors (DTIs) offer several mechanistic advantages over heparin in the management and treatment of ACS, including ST-segment elevation myocardial infarction, and for percutaneous coronary intervention (PCI); these include free and clot-bound thrombin inhibition and consistent dosing.

Christopher Allen, MD

The American Heart Association (AHA) Scientific Sessions 2010 were held in Chicago, IL, USA. Several trials that are of interest to those caring for patients with ACS were presented. Eleven of these trials are discussed in this report.